Diagnosis

Visit your doctor

If you’re experiencing any of the signs and symptoms described here, be sure to see your doctor. What you can expect at that appointment is that your doctor will obtain a thorough history of your symptoms, as well as any family history of pancreatic cancer. Your doctor will also perform a physical exam, looking specifically for abdominal tenderness, fluid in the abdomen (ascites), or signs of bile duct blockage. He/she will also assess your lymph nodes for swelling, and assess for other possible causes of your symptoms. Your doctor may also order other tests, including blood and urine samples, or imaging tests

Imaging Studies

There are several types of imaging techniques available to help detect pancreatic cancer. The information each provides varies somewhat, and they often complement one another. Your doctor will choose which ones are most appropriate for your particular situation. Often, the first step is computed tomography (CT scan). Ultrasonography may also be used, either from the outside of the body, or from inside. This latter method is often performed by a gastroenterologist, and the technique is referred to as endoscopic ultrasound (EUS). This method may be particularly helpful in performing biopsies (see below). A gastroenterologist may also be involved to perform endoscopic retrograde cholangiopancreatography (ERCP). This technique allows for biopsy, as well as imaging of the bile duct system, and the placement of a stent, if one is needed, to relieve symptoms including jaundice. Similar images can be obtained using magnetic resonance imaging (MRI), or in particular, magnetic resonance cholangiopancreatography (MRCP)

As noted above, some of these imaging studies are involved in performing a biopsy. This is the process by which a tissue sample is obtained. This is important for confirming a diagnosis by looking at the tissue cells under a microscope. Occasionally, cells may be obtained in the operating room, using a minimally invasive technique called laparoscopy

Staging

The staging system for cancer is a standardized way to classify the extent of disease. It measures how large the tumor is, if it has spread, and to where it has spread. This staging system is important for helping you and your doctor make the right treatment decisions. It is based upon the TNM classification system, developed by the American Joint Committee on Cancer. Each patient’s disease is evaluated on the primary tumor (T), the lymph nodes (N), and sites of spread of the tumor, or metastases (M). From these classifications, the cancer is categorized into the appropriate stage, ranging from Stage 0 to Stage IV

More typically however, your doctor will use a clinical classification system. This system evaluates the extent of disease in a more descriptive manner – whether the tumor may be surgically removed (resected). Resectable cancers can be removed surgically because the nearby critical arteries and veins are not involved. Locally advanced tumors are confined to the area around the pancreas, but do involve these critical arteries and veins, and are therefore not easily resected. The third category is metastatic cancer – these tumors show evidence of spread to other organs, and surgery to remove the primary tumor in the pancreas will not cure the disease